Jones Hall - Insurance CertificateACC? CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY)
9/28/2011
PRODUCER (415) 978 -3800 FAX: (415) 978 -3825 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Calender- Robinson Company, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
FB0267063 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
300 Montgomery St., Suite 888
San Francisco CA 94104 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Hartford Casualty Ins. Co. 29424
JONES HALL, A PROFESSIONAL LAW CORPORATION INSURER B: Republic Indemnity Company of America 22179
650 CALIFORNIA STREET, #1800 INSURER C:
INSURER D:
SAN FRANCISCO CA 94108 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADD'
POLICY EFFECTIVE ! POLICY EXPIRATION
EM
LTR
POLICY NUMBER
E M &M! M LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY
PREMISES Ea occurrence
$ 300,000
A
CLAIMS MADE 1XI OCCUR
57SBANK7611
10/1/2011
10/1/2012
MED EXP (Any one person)
$ 10,000
(PERSONAL &ADVINJURY
$ 2,000,000
GENERAL AGGREGATE
$ 4,000,000
G AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 4,000,000
n PRO
X POLICY LOC JECT
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $ 2,000,000
ANY AUTO
(Ea accident)
A
ALL OWNED AUTOS
57SBANK7611
10/1/2011'.
10/1/20121 BODILY INJURY
� SCHEDULED AUTOS
(Per person) $
X HIRED AUTOS
��
BODILY INJURY $
X NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
(Per accident) $
I GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS / UMBRELLA LIABILITY
EACH OCCURRENCE
$ 1,000,000
X OCCUR CLAIMS MADE
AGGREGATE
$ 1,000,000
$
A
DEDUCTIBLE
57SBANK7611
10/1/2011
10/1/2012
$
$
X I RETENTION $ 10,000
B WORKERS COMPENSATION
X WC STATU- lull,-!
T RY I I ER
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE �
E.L. EACH ACCIDENT
$ 1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
168749 -06
4/1/2011 4/1/2012
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT I
$ 1,000,000
OTHEREMPLOYEE BENEFITS
57SBANK7611
10/1/2011 10/1/2012
EACH CLAIM $2,000,000
A BUSINESS PERSONAL
AGGREGATE $4,000,000
PROPERTY
T.TMTT $2,639,400
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Re: Covered Loc. Deer Park CFD
City of Gilroy is named as additional insured as per the attached endorsement - NOTE: 10 day notice of cancellation
for non - payment of premium
CERTIFICATE HOLDER CANCELLATION
sandra.meditch@ci.gilroy.c
City of Gilroy
Attn: Sandra A. Meditch, P.E.
7351 Rosanna Street
Gilroy, CA 95020
ACORD 25 (2009/01)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
1988-2009
IN5025 (200901).01 1 ne AGURU name and IOgo are registered marKs Ot AGURD
rights reserved.
POLICY NUMBER: 57SBANK7611 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - - -- DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
City of Gilroy
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule as an insured but only with respect to liability arising out of your work, operations or premises owned by
or rented to you.
CG 20101185 Copyright, Insurance Services Office, Inc. 1984
,aco CERTIFICATE OF LIABILITY INSURANCE DATE /2/2DD/YYYY)
� 4i2i2o12
PRODUCER (415) 978 -3800 FAX: (415) 978 -3825 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Calender- Robinson Company, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
FB0267063 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
300 Montgomery St., Suite 888
San Francisco CA 94104 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Hartford Casualty Insurance 29424
JONES HALL, A PROFESSIONAL LAW CORPORATION INSURER B: Republic Indemnity Co of
650 CALIFORNIA STREET, #1800 INSURER C:
INSURER D:
SAN FRANCISCO CA 94108 INSURER E:
GnVFRAr;FA
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INTR
DD'
TYPE F IN RANCE
POLICY NUMBER
CY EXPIRATION
DATE MM DDC/YYYY DATE MM /DD..... I
LIMITS
�GGIENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
A
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR
10/1/2011
10/1/2012
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 2,000,000
�7s:BANK7611
GENERAL AGGREGATE
$ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 4,000,000
j X POLICY PRO- LOC
AUTOMOBILE
LIABILITY
ANY AUTO
Ea accideDtSINGLELIMIT
$ 2,000,000
BODILY INJURY
(Per person)
A
ALL OWNED AUTOS
SCHEDULED AUTOS
57SBANK7611
10/1/2011
10/1/2012
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE
LIABILITY
AUTO ONLY - EA ACCIDENT
$
$
ANY AUTO
OTHER THAN EA ACC
$
AUTO ONLY: AGG
EXCESS /UMBRELLA LIABILITY
OCCUR I CLAIMS MADE
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
$
A
DEDUCTIBLE
57SBANK7611 1 10/1/2011
10/1/2012
A�STATU
$
X RETENTION $ 10,000
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
X O TH-
E.L. EACH ACCIDENT Is
1,000,000
ANY PROPRIETOR/PARTNER /EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE!
$ 1,000,000
(Mandatory in NH)
If y SPECIAL PROVISIONS below
168749 -07
4/1/2012
4/1/2013
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHEREMPLOYEE BENEFITS
57SBANK7611 10/1/2011 10/1/2012
EACB CLAim $2,000,000
A
BUSINESS PERSONAL
AGGREGATE $4,000,000
PROPERTY
$2,639,400
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Gilroy, its officers, officials and emplyees are named as additional insureds on the general liability policy
but only with respect to liability arising out of the named insured's operations or premises owned by or rented to the
named insured with respect to formation of a landscape maintenance community facilities district.
NOTE: SO day notice of cancellation applies for non - payment of premium
yGR I IrIVM I G f1V1_NCR F.ANtrtLLA 1 IUN
City of Gilroy
Attn: Teresa Mack
7351 Rosanna Street
Gilroy, CA 95020
ACORD 25 (2009/01)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL NNAVOYLUMAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
AUTHORIZED REPRESENTATIVE
IN5OZ5 (200901).01 The ACORD name and logo are registered marks of ACORD
TlnN_ All rinhf t maorworl
,4co CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY)
� 4i2i2o12
PRODUCER (415) 978 -3800 FAX: (415) 978 -3825 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Calender- Robinson Company, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
FB0267063 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
300 Montgomery St., Suite 888
San Francisco CA 94104 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA:Hartford Casualty Insurance 29424
JONES HALL, A PROFESSIONAL LAW CORPORATION INSURER B: Republic Indemnity Co of
650 CALIFORNIA STREET, #1800 INSURER C:
INSURER D:
SAN FRANCISCO CA 94108 INSURER E: j
COVFRAnFA
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TR DD
PE F IN
INSURANCE
POLICY NUMBER
DATE MM DD/YYYY
DATE MM /DID%YOY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE LJ' OCCUR
57SBANK7611
10/1/2011
10/1/2012
DAMAGE TO RENTED
PREMISES Ea occurrence)
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL BADV INJURY
$ 2,000,000
GENERAL AGGREGATE
$ 4,0 0, 000
j
GEN 'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO- LOC JECT
PRODUCTS - COMP /OP AGG
$ 4,000,000
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$ 2,000,000
BODILY INJURY
(Per person)
$
A
ALL OWNED AUTOS
SCHEDULED AUTOS
57SBANK7611
10/1/2011
10/1/2012
X
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
j OTHER THAN EA ACC
AUTO ONLY: AGG
$
ANY AUTO
$
EXCESS/ UMBRELLA LIABILITY
Al OCCUR CLAIMS MADE
EACH OCCURRENCE
$ 11000,000
AGGREGATE
$ 1,000,000
A
DEDUCTIBLE
57SBANK7611
10/1/2011
10/1/2012
$
$
X RETENTION $ 10,000
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑,
OFFICER /MEMBER EXCLUDED?
(Mandatory in NH) 168749 -07 4/1/2012
If yes, describe under
i 4/1/2013
WC STATU- OTH-
X R
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHEREMPLOYEE BENEFITS
57SBANK7611
10/1/2011
10/1/2012
EACH CLAIM $2,000,000
A
BUSINESS PERSONAL
AGGREGATE $4,000,000
PROPERTY
$2,639,400
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Re: Covered Loc. Deer Park CFD
City of Gilroy is named as additional insured as per the attached endorsement - NOTE: 10 day notice of cancellation
for non - payment of premium
I c MULL rK
sandra.meditch @ci.gilroy.c
City of Gilroy
Attn: Sandra A. Meditch, P.E.
7351 Rosanna Street
Gilroy, CA 95020
ACORD 25 (2009/01)
SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
INS025 (200901).01 The ACORD name and logo are registered marks of ACORD
TION. All rights reserved